Diagnosis and treatment of multiple nerve entrapment in the brachial plexus / 中华创伤骨科杂志

ABSTRACT

Objective To discuss the diagnosis and treatment of a variety of multiple nerve entrapment in the brachial plexus and around anterior and middle scalene muscles in 179 cases.Methods From July 2003 to January 2006,179 outpatients in our department were diagnosed as thoracic outlet syndrome(TOS)with a variety of symptoms of the nerve entrapment in the brachial plexus and around anterior and middle scalene muscles.They were treated with drugs,local block injections,or operations,depending on their severity of the condition. Results Of the 128 cases who were followed up for one to 29 months,the symptoms were significantly relieved with drugs and massage in 55 cases,with local block injection in 58 cases of whom 24 received the second in- jection,with operation in 15 cases of whom 10 returned to work.One of the operated cases reported symptoms of injury to the long thoracic nerve which responded to further therapy.The visual analogue scale(VAS)evaluations after the first injection were one point in two cases,two points in 16 cases,three points in 20 cases,four points in 12 cases,five points in three cases,six points in three cases,and seven points in two cases.The VAS scores after the second injection were two points in five cases,three points in 16 cases,and four points in three cases. Conclusions The entrapment of the anterior anti middle scalene muscles can affect many nerves around the muscles,and cause clinical symptoms other than the TOS ones.The conservative treatment,such as drug,massage, and local block injection,can work well.When the non-operative methods do not work,operation can be consid- ered.